Kaneko H, Takagi S, Shiba T
Second Department of Surgery, Toho University School of Medicine, Tokyo, Japan.
Surgery. 1996 Sep;120(3):468-75. doi: 10.1016/s0039-6060(96)80065-1.
Technical difficulties have impeded the development of laparoscopic hepatectomy. This article describes a new technique for performing partial hepatectomy and left lateral segmentectomy by means of laparoscopy, and the results in a series of 11 consecutive patients are reported.
A microwave tissue coagulator is used in combination with an ultrasonic surgical aspirator to divide hepatic parenchyma without pneumoperitoneum. Branched vessels and ducts are clipped and transected. The largest vessels were suture ligated in some cases. The endoscopic linear stapler was used to transect the left hepatic vein for left lateral segmentectomy. The resected liver was maneuvered into a specimen bag and removed. The argon beam coagulator was used to secure hemostasis of the plane of transection.
Eleven patients underwent laparoscopic hepatic resection. Indications included isolated metastatic lesion, hepatocellular carcinoma, hemangioma, Wilson's disease, and hemochromatosis. Three patients underwent left lateral segmentectomy, and eight underwent partial hepatectomy. Ten procedures were performed uneventfully; one patient required conversion to open hepatectomy because of excessive bleeding. Notable differences were seen in blood loss compared with open hepatectomy, and no operative complications occurred. Postoperative pain was minimal.
The laparoscopic hepatectomy, especially partial or left lateral segmentectomy, appears to be a viable surgical alternative in selected cases.
技术难题阻碍了腹腔镜肝切除术的发展。本文介绍一种通过腹腔镜进行部分肝切除术和左外叶肝切除术的新技术，并报告连续11例患者的手术结果。
使用微波组织凝固器联合超声外科吸引器在无气腹状态下离断肝实质。对分支血管和胆管进行夹闭和横断。在某些情况下，对最大的血管进行缝合结扎。使用内镜直线切割缝合器横断左肝静脉以进行左外叶肝切除术。将切除的肝脏放入标本袋并取出。使用氩气刀确保肝断面止血。
11例患者接受了腹腔镜肝切除术。手术适应证包括孤立性转移瘤、肝细胞癌、血管瘤、威尔逊病和血色素沉着症。3例患者接受左外叶肝切除术，8例接受部分肝切除术。10例手术顺利完成；1例患者因出血过多而中转开腹肝切除术。与开腹肝切除术相比，术中出血量有显著差异，且未发生手术并发症。术后疼痛轻微。
在特定病例中，腹腔镜肝切除术，尤其是部分肝切除术或左外叶肝切除术，似乎是一种可行的手术选择。
